Do PRO Measures Function the Same Way for all Individuals With Heart Failure?

•Women have different lived experiences with heart failure, and different experiences could influence patients’ interpretations of patient-reported outcome (PRO) items.•A presumption in the use of PRO measures is that patients interpret PRO questions similarly, regardless of their race, ethnicity, gender, etc.•When 2 groups of patients (eg, men and women, older and younger patients, various racial groups) interpret and respond to a PRO item differently for reasons other than the outcome of interest, differential item functioning (DIF) is present.•Without formally testing for DIF, it is possible that conclusions drawn from studies using PRO measures are biased, either by revealing subgroup differences that do not actually exist or by masking subgroup differences that really do exist.•As we strive toward equity in health outcomes, it is important that the tools we use to measure outcomes are not biased, and DIF evaluations provide a tool for examining our patient-reported outcome measures in heart failure and beyond.